1. SNOMED CT – Distributed Content Management Stefan Schulz Content Committee April 2, 2009

2. Problem statement SNOMED CT’s size: barrier for effective content management and redesign Any action on SNOMED as a whole is a major undertaking Only a small fraction of this material has ever been used Concentration on quality-assured subset recommended Alan Rector (2008): Semantic Interoperability Deployment and Research Roadmap http://www.semantichealth.org/DELIVERABLES/SemanticHEALTH_D6_1.pdf

3. SNOMED CT: Ontology + Vocabulary SNOMED – CT Ontology (concepts, relations) SNOMED – CT Vocabulary (descriptions) SNOMED CT

4. SNOMED CT Ontology SNOMED – CT Ontology (concepts, relations) SNOMED – CT Vocabulary (descriptions) Basic Core (BC) Natural primitives constituting the conceptual “atoms” of the domain. entire esophagussarcomaL-carnitineIntensive care unitStenosis

5. SNOMED CT Ontology SNOMED – CT Ontology (concepts, relations) SNOMED – CT Vocabulary (descriptions) Basic Core (BC) Extended Core (EC) Natural primitives constituting the conceptual “atoms” of the domain. Clinically relevant frequent concepts that are (could be) expressed by full definitions esophagitisesophageal neoplasmentire left upper extremitySevere asthma

6. SNOMED CT Ontology SNOMED – CT Ontology (concepts, relations) SNOMED – CT Vocabulary (descriptions) Basic Core (BC) Extended Core (EC) Authoritative Concepts (AC) Natural primitives constituting the conceptual “atoms” of the domain. Clinically relevant frequent concepts that are (could be) expressed by full definitions Primitive Concepts for which a SNOMED CT independent, authoritative source exists prednisolone 50 mg tabletL-Carnitine productnurse – RAFGeorgia stateLeishmania donovani

7. SNOMED CT Ontology SNOMED – CT Ontology (concepts, relations) SNOMED – CT Vocabulary (descriptions) Basic Core (BC) Extended Core (EC) Authoritative Concepts (AC) Precoordinated Concepts (PC) Natural primitives constituting the conceptual “atoms” of the domain. Clinically relevant frequent concepts that are (could be) expressed by full definitions Primitive Concepts for which a SNOMED CT independent, authoritative source exists Fully defined but idiosyncratic concepts Abrasion AND/OR friction burn of ear with infection,Injection of triamnicolone into nail bed,Deep third degree burn of forehead AND/OR cheek with loss of body part

8. SNOMED CT Ontology SNOMED – CT Ontology (concepts, relations) SNOMED – CT Vocabulary (descriptions) Basic Core (BC) Extended Core (EC) Authoritative Concepts (AC) Precoordinated Concepts (PC) Contextual Concepts (CC) Natural primitives constituting the conceptual “atoms” of the domain. Clinically relevant frequent concepts that are (could be) expressed by full definitions Primitive Concepts for which a SNOMED CT independent, authoritative source exists Fully defined but idiosyncratic concepts Concepts, fully defined or not, that describe a clinical situation, belief state or database entry implementation of planned interventionsTake at regular intervals. Complete the prescribed course unless otherwise directedNo antenatal care: not known pregnantPrevious known suicide attempt

9. SNOMED CT Ontology SNOMED – CT Ontology (concepts, relations) SNOMED – CT Vocabulary (descriptions) Basic Core (BC) Extended Core (EC) Authoritative Concepts (AC) Precoordinated Concepts (PC) Contextual Concepts (CC) Natural primitives constituting the conceptual “atoms” of the domain. Clinically relevant frequent concepts that are (could be) expressed by full definitions Primitive Concepts for which a SNOMED CT independent, authoritative source exists Fully defined but idiosyncratic concepts Concepts, fully defined or not, that describe a clinical situation, belief state or database entry   

10. SNOMED CT: Ontology + Vocabulary SNOMED – CT Ontology (concepts, relations) SNOMED – CT Vocabulary (descriptions) SNOMED CT

11. SNOMED CT: Vocabulary SNOMED – CT Vocabulary (descriptions) FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) FSN Fully Specified Name ”malignant tumor of esophagus (disorder)”

12. SNOMED CT: Vocabulary SNOMED – CT Vocabulary (descriptions) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) FSN Fully Specified Name PT Preferred Term ”malignant tumor of esophagus”

13. SNOMED CT: Vocabulary SNOMED – CT Vocabulary (descriptions) FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) RS: Carries the same meaning as the corresponding FSN or PT FSN Real Synonym Fully Specified Name RS PT Preferred Term “esophageal carcinoma”

14. SNOMED CT: Vocabulary SNOMED – CT Vocabulary (descriptions) FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) RS: Carries the same meaning as the corresponding FSN or PT NS: term with a broader meaning, but in many contexts used as synonym to the related FSN FSN Real Synonym Fully Specified Name RS Near Synonym NS PT Preferred Term “foot” (body part vs. length unit),“fundus” for “uterine fundus”“appendectomy” for „open appendectomy“

15. SNOMED CT: Vocabulary SNOMED – CT Vocabulary (descriptions) FSN Real Synonym Fully Specified Name RS Text Definition Near Synonym NS TDPT Preferred Term FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) RS: Carries the same meaning as the corresponding FSN or PT NS: term with a broader meaning, but in many contexts used as synonym to the related FSN TD: Glossary-like definition that refines the description given by the Fully Specified Name. “Intertrigo (disorder) - Superficial dermatitis on opposed skin surfaces”

16. SNOMED CT: Vocabulary SNOMED – CT Vocabulary (descriptions) FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) RS: Carries the same meaning as the corresponding FSN or PT NS: term with a broader meaning, but in many contexts used as synonym to the related FSN TD: Glossary-like definition that refines the description given by the Fully Specified Name. FSN Real Synonym Fully Specified Name RS Near Synonym NS TDPT Preferred Term Text Definition

17. SNOMED CT: Vocabulary * Ontology SNOMED – CT Vocabulary (descriptions) FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) RS: Carries the same meaning as the corresponding FSN or PT NS: term with a broader meaning, but in many contexts used as synonym to the related FSN TD: Glossary-like definition that refines the description given by the Fully Specified Name. BC: Natural primitives constituting the conceptual “atoms” of the domain. EC: Clinically relevant frequent concepts that are (could be) expressed by full definitions AC: Primitive Concepts for which a SNOMED CT independent, authoritative source exists PC: Fully defined but idiosyncratic concepts CC: Concepts, fully defined or not, that describe a clinical situation, belief state or database entry SNOMED Ontology (concepts, relations)

18. FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) RS: Carries the same meaning as the corresponding FSN or PT NS: term with a broader meaning, but in many contexts used as synonym to the related FSN TD: Glossary-like definition that refines the description given by the Fully Specified Name. BC: Natural primitives constituting the conceptual “atoms” of the domain. EC: Clinically relevant frequent concepts that are (could be) expressed by full definitions AC: Primitive Concepts for which a SNOMED CT independent, authoritative source exists PC: Fully defined but idiosyncratic concepts CC: Concepts, fully defined or not, that describe a clinical situation, belief state or database entry SNOMED CT: Language Dimension SNOMED – CT Vocabulary (descriptions) SNOMED Ontology (concepts, relations)

19. Stakeholders and Roles SNOMED CT Ontology Terms IHTSDO National Release Centers Affiliates User Groups Other SDOs maintain propose assure quality audit propose translate

20. Possible Distributed Management … propose maintain propose maintain propose maintain User groups provide names, meaning, and IDs External authoritative sources audit (others) translate (?) main- tain (others) main- tain (others) main- tain (other) propose maintain propose maintain translatequality assess- ment National Release Centers audit (english) fully main- tain fully main- tain (english) fully main- tain (english) fully main- tain (english) audit quality assess- ment audit quality assess- ment define sources, manage IDs fully main- tain IHTSDO NSTDRSPTFSNCCPCACECBC SNOMED CT descriptionsSNOMED CT Concepts Consequences: “outsourcing” of many pre-coordinated concepts and synonyms: under the responsibility of user groups. IHTSDO’s role: audit and quality assurance. IHTSDO mostly concentrates on BC and EC Use of IDs from external namespaces

21. Example 1 Now: –user proposes a new concept C –IHTSDO processes request –IHTSDO finds concept definition –IHTSDO includes C into new SNOMED release Future –user proposes a new concept C –user uploads to common repository –users discuss suitable definition –IHTSDO approves FSN and formal definition –IHTSDO decides whether to leave in repository or include in terminology

22. Example 2 Now: –National Release Center translates concept C Future –user proposes a translation to concept C –user uploads proposal to common repository –users discuss –National Release Center approves translation

23. Open issues tooling management of identifiers, namespaces etc. intellectual property issues workflows quality control referential integrity …